HSE Investigation template and guidance Non Accidental Death (NAD) HSE Incident Investigation guidance notes HSE Investigation template and guidance Non Accidental Death (NAD) First 5 slides are for guidance only and should be removed but used as reference, prior to draft 1 being submitted

Non Accidental Death Name of Company Date of Incident

Name of Company and incident date Incident details PDO directorate/dept : (e.g. OSD /OSO/OSO4) Contractor name/number: (subcontractor-contractor-PDO)/CXXXXXX Incident owner : Name / Ref Ind of the Director Location : Area / unit - (road/yard/station/rig/hoist/plant etc) Incident date & time : (d/m/yr) / (24 hour clock) – advise if estimated Incident type : Non Accidental Death (NAD) Actual severity rating : Number (1-5) / letter (P, E, A,R) – from RAM PIM ID : Number assigned in PIM Immediate cause of Death : Short description of what caused the death Previous NAD : Include PIM number, short description of last (LTI/ NAD) of the contractor, this applicable to all contracts with PDO and not specified to a specific contract No. Key Mgmt Failure : Key Management system failure from conclusion slide including number No variation to the slide is allowed

Name of Company and incident date Key Information about the deceased Name of deceased: DOB and age: Marital status and number of children and their age : Nationality: Duration of service with the company: HSE trainings and induction: Work schedule and date of last leave: Number of children must include their ages and what sex they are

Name of Company and incident date Summary Description of the incident: On ------------- This should be free text writing and include the relevant facts explaining what happened to all the relevant parties in a short sharp factual paragraph that describes the incident. The description should be in sufficient detail to allow a person who does not know anything about the incident to imagine it. It should only be about what happened and not why it happened. Include a short comment on emergency response. Do not include investigation findings here, simply describe the incident as the investigation has shown it happened.

Name of Company and incident date Description of the Medical Emergency Response (MER) : Briefly in few words describe MER response by co-workers/bystanders: Briefly in few words describe response by First Aiders and how long it took them to reach to the scene: Briefly in few words describe response by Medics and how long it took them to reach to the scene and use of defibrillator (AED):

Name of Company and incident date Past Medical history- Find out about Pre-existing Medical problems and Medications: Date of Pre-employment and last medical check up and was he declared fit? Was the FTW medical carried out in a PDO approved Clinic? Did the deceased attend the clinic or had any complaints before his death during this work period? Pre-existing Medical problems and Medications. NOTE* Include any personal medical treatment arrangements done by individuals if known and applicable

Name of Company and incident date Life style and social issues Find out about life style issues: smoking habits Alcohol drug abuse exercise activities dietary habits Obesity / BMI Find out about his social interactions and relations with colleagues:

Name of Company and incident date Work Environment and Accommodation conditions Find out and investigate if there are any accommodation or work related health hazards eg contact with hazardous substances or poor work environment which could have contributed to the death:

Name of Company and incident date Contractual Health Management Find out about the health management in contracts within the direct working environment of the deceased e.g completion of health risk assessments, exposure monitoring, health controls, health awareness, MER drills and is Health activities included into the annual HSE plans and are they monitored by contractors and PDO CH’s Ensure evidence of health risk assessments specific to deceased role is provided

Name of Company and incident date Key investigation findings: List all the important findings

Name of Company and incident date Conclusions: Immediate Cause of Death: Underlying Causes of Death: If it was not possible to definitively establish the underlying causes, however based on circumstantial evidence the following is possible: Management system failure: MSF Ref No # ICAM Mgt System Failure Description Justification for Management System Failure cited Ensure you use ICAM when inputting Management System Failures Immediate Cause of Death: As per Doctors reports

Name of Company and incident date Immediate actions taken if any: No. Actions Date of action Status 1 2 3 Immediate actions taken include all those reported to have been taken and completed within one week of the incident in a table. Report the five most important immediate actions to prevent a reoccurrence in the future. These may be tracked for completion by the MSE team and reported to MDIRC.

Name of Company and incident date Recommendations(Actions) Remedial Action / Recommendations: No. Recommendations(Actions) Target Date Action Party (Contractor) Action Party (PDO) Status 1 2 3 Report the most important remedial actions to prevent a reoccurrence in the future first, these may be tracked for completion by the MSE team and reported to MDIRC.

Name of Company and incident date Incident Review Committee Contractor Commitment Declaration I, Mr. …………………………….…………………. CEO, and I, Mr. ………………………………………………. Operations Manager Of the Company: …………………………………. We have signed below to demonstrate to PDO our commitment to personally conduct the necessary follow up to ensure the effective implementation of the agreed actions contained in the IRC endorsed investigation in all our units, and to demonstrate our personal leadership in implementing the necessary consequence management in case of re-occurring of similar incident. Moreover, we will disseminate the learning from this incident to all our workforce and our subcontractors. Mr. ……………………     Signature:………………………… Date:……………….. One of the most important additions to the new process is the contractor commitment sign off Here the CEO or senior manager agrees their commitment in writing in front of the PDO Director or MD stating that they will ensure all actions are implemented, contract holder informed for PIM closeout and that they will show adequate leadership to improve safety and prevent a re-occurrence They also agree to pass on the learning's to their workforce and sub-contractors

PDO Second Alert Photo explaining what was done wrong Date: Incident title What happened? Short description of what happened Your learning from this incident.. (This must solely relate to the people at risk of harm or people at risk of causing the harm) Learning points for them from the investigation Photo explaining what was done wrong Photo explaining how it should be done right No names or detail of company to link this to any recent specific incident Strap line – should be the key (keep short and memorable )

Management self audit Date: Incident title As a learning from this incident and ensure continual improvement all contract managers must review their HSE HEMP against the questions asked below Confirm the following: 1 2 3 4 5 Make a list of closed questions (only ‘yes’ or ‘no’ as an answer) to ask other contractors if they have the same issues based on the management or HSE-MS failings or shortfalls identified in the investigation. Pretend you have to audit other companies to see if they could have the same issues.

Name of Company and incident date Health Management CHECK List - Please confirm Do you report and investigate all occupational illnesses and NADs? Are you using a PDO approved clinics for conducting PDO specific fitness to work medical examinations? and do your medical staff review and scrutinize the submitted reports to confirm conformance to PDO standards? Are all your staff up to date with their periodic medical check? Do you track and keep list of all employees with chronic medical conditions such as diabetes, high BP etc Do you obtain timely medical waiver for your employees who are above 60 years of age? Do you obtain PDO medical department approval and familiarization for your medical staff prior to deployment to PDO sites? Is health management within the direct working environment of the deceased meeting Company standards? And do you encourage your staff to seek medical help if feeling unwell? Do you ensure calibration of Medical equipments including AED and carry out daily ambulance inspection ? Do your medics attend regular continuous medical education sessions and have valid MOH license and ACLS certification? Do you have MER plan and do you conduct medical drills? Do you have a clear Alcohol and drugs policy? Do you submit to PDO the monthly health performance report? Do you conduct regular health awareness to your staff? Is health activities included into the annual HSE plans?

Name of Company and incident date Sequence of events, during and post incident response – Timeline No. Date Time Description of event 1 2 3 4 5 6 7 8